Urban and Rural Prevalence of Tuberculosis in Low- and Middle-Income Countries: A Systematic Rev

by Seyed Alireza Mortazavi, Nicole A. Swartwood, Nanki Singh, Melike Hazal Can, Hening Cui, Do Kyung Ryuk, Katherine C.

Horton, Nicolas A. Menzies, Peter MacPherson Background Urban and rural settings differ in key determinants of tuberculosis (TB) burden, including transmission dynamics, social and structural determinants, and healthcare access.

However, understanding of urban and rural TB burden is limited, hindering implementation of public health interventions to end TB. Methods and findings We conducted a systematic review and meta-analysis of urban and rural differences in adult pulmonary TB prevalence in low- and middle-income countries.

We searched PubMed, Embase, Global Health, the Cochrane Library, Africa Index Medicus, LILACS, and SciELO for community-representative prevalence surveys conducted between 1st January 1993 and 14th October 2025. Studies focussing solely on symptomatic or healthcare-seeking individuals and those conducted in congregate settings like prisons, universities, and health facilities were excluded.

Risk of bias was assessed using a tool for prevalence surveys. Bayesian multilevel meta-regression was used to estimate pooled urban-to-rural prevalence ratios (PR) for bacteriologically-confirmed and smear-positive TB overall, and by World Health Organization (WHO) region.